ClaimsIQ helps TPAs by cleaning up data, correcting incoming claims to increase efficiency and reduce manual review time, all on top of your existing adjudication systems.
Intelligent claims processing that works alongside your existing systems
ISA*00*...*ZZ*SENDER*...
GS*HC*SENDER*RECEIVER*...
ST*837*0001*005010X222A1~
• Accurate provider and member info
• AI insights for claim review
• Anomaly detection and alerts
Our system works alongside your existing claims processing software, providing AI-enhanced capabilities without disrupting current workflows.
Seamlessly ingests raw X12 837 files via API or SFTP — no system changes required.
Cleans, validates, and corrects claims data to boost auto-adjudication and reduce manual rework.
Adjudicators get structured, AI-assisted views to make faster, more accurate decisions.
Audits every single claim, surfaces insights and proactive recommendations to improve your processes.
Our platform combines advanced AI with healthcare expertise to streamline claims processing.
Match member data to eligibility records.
Auto-correct typos with smart string matching.
Validate provider info (e.g., Baseload, NPI and address verification).
Catch surprises early, prepare for claims outside of normal.
Match claims with pre-auth, improve experience for members and providers.
Full-scale AI-assisted auditing and real time visibility into claims flow.
Our system is designed to work alongside your existing claims processing infrastructure.
Seamless Integration: Works alongside your existing TPA software without disrupting current workflows